Provider Demographics
NPI:1871800938
Name:CRAIG, CHERYL ANTONIA (RD)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANTONIA
Last Name:CRAIG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49114 BARRYMORE ST
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-7508
Mailing Address - Country:US
Mailing Address - Phone:626-255-2576
Mailing Address - Fax:
Practice Address - Street 1:49114 BARRYMORE ST
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-7508
Practice Address - Country:US
Practice Address - Phone:626-255-2576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA710791133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered